An assessment of the impact of trauma systems consultation on the level of trauma system development.
BACKGROUND
Studies have shown that trauma systems decrease morbidity and mortality after injury. Despite these findings, overall progress in system development has been slow and inconsistent. The American College of Surgeons Committee on Trauma (COT) has developed a process to provide expert consultation to facilitate regional trauma system development. This study evaluated the progress that occurred after COT consultation visits in six regional systems.


METHODS
All six trauma systems undergoing COT consultation between January 1, 2004 and September 1, 2006 were included in the study. Using a set of 16 objective indicators, preconsultation status was retrospectively assessed by members of the original consultation team using data from the final consultation reports. Postconsultation status was assessed by directed telephone conference, conducted by members of the original consultation team with current key representatives from each system. Progress was assessed by comparing changes in both aggregate and individual indicator scores.


RESULTS
This study showed a statistically significant increase in aggregate indicator scores after consultation. The largest gains were seen in systems with the longest time interval between the two assessments. Individual indicators related to system planning and quality assurance infrastructure showed the most improvement. Little or no change was seen in indicators related to system funding.


CONCLUSIONS
The COT consultation process appears to be effective in facilitating regional trauma system development. In this short-term followup study, progress was seen primarily in areas related to planning and system design. Consultation was not effective in helping systems secure stable funding.
Winchell
Robert J
RJ
Division of Trauma and Burn Surgery, Maine Medical Center, Portland, ME 04102, USA.
Ball
Jane W
JW
Cooper
Gail F
GF
Sanddal
Nels D
ND
Rotondo
Michael F
MF
D001291:Attitude of Health Personnel; D019985:Benchmarking; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D016730:Program Development; D012017:Referral and Consultation / Q000458:organization & administration*; D012040:Regional Health Planning / Q000458:organization & administration*; D012189:Retrospective Studies; D013597:Systems Analysis; D014194:Traumatology / Q000458:organization & administration*